Peripheral Arterial Disease, or PAD, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged. PAD is sometimes called peripheral vascular disease, or PVD. This interferes with the normal flow of blood, sometimes causing pain but often causing no symptoms at all.
The most common cause of PAD is atherosclerosis (often called hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels. In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow.

How common is PAD?

Peripheral Arterial Disease affects about 1 in 20 people over the age of 50, or 10 million people in the United States. More than half the people with PAD experience leg pain, numbness or other symptoms — but many people dismiss these signs as "a normal part of aging" and don’t seek medical help. Only about half of those with symptoms have been diagnosed with PAD and are seeing a doctor for treatment.

What are the symptoms of PAD?

The most common symptom of PAD is painful cramping in the leg or hip, particularly when walking. This symptom, also known as "claudication," occurs when there is not enough blood flowing to the leg muscles during exercise. The pain typically goes away when the muscles are given a rest.

Other symptoms may include numbness, tingling or weakness in the leg. In severe cases, you may experience a burning or aching pain in your foot or toes while resting, or develop a sore on your leg or foot that does not heal. People with PAD also may experience a cooling or color change in the skin of the legs or feet, or loss of hair on the legs. In extreme cases, untreated PAD can lead to gangrene, a serious condition that may require amputation of a leg, foot or toes. If you have PAD, you are also at higher risk for heart disease and stroke. Unfortunately, the disease often goes undiagnosed because many people do not experience symptoms in the early stages of PAD or they mistakenly think the symptoms are a normal part of aging.

Leg or hip pain during walking

The pain stops when you rest

Numbness, tingling or weakness in the legs

Burning or aching pain in feet or toes when resting

Sore on leg or foot that won’t heal

Cold legs or feet

Color change in skin of legs or feet

Loss of hair on legs

Who is at risk for PAD?

As many as 10 million people in the U.S., or about 1 in 20, may have PAD. The disease affects everyone, although men are somewhat more likely than women to have PAD. Those who are at highest risk are:

over the age of 50,

smokers,

diabetic,

overweight,

people who do not exercise, or

people who have high blood pressure or high cholesterol.

A family history of heart or vascular disease may also put you at higher risk for PAD.

How can PAD be treated?

The best treatment for PAD depends on a number of factors, including your overall health and the seriousness of the disease. In some cases, lifestyle changes are enough to halt the progress of PAD and manage the disease. Sometimes, medications or procedures that open up clogged blood vessels are prescribed to treat PAD.

Lifestyle changes

In many cases, changes in lifestyle are enough to slow the progression or even reverse symptoms of PAD. Most treatment plans will include a low fat diet and a program of regular exercise.

If you are a smoker, it is absolutely essential that you stop the use of all types of tobacco.

If decreased blood flow to the legs is causing injury to the feet and toes, a foot care program to prevent sores or infection may be prescribed. This may include referral to a podiatrist.

Exercise

Research has shown that regular exercise is the most consistently effective treatment for PAD. In study after study, patients who have taken part in a regular exercise program for at least three months have seen substantial increases in the distances they are able to walk without experiencing painful symptoms.

Exercise programs that have been effective include simple walking regimens, leg exercises and, most commonly, treadmill exercise programs three to four times every week for a period of several months. Some people may have a medical condition that prevents them from participating in an exercise program. Consult with your physician before undertaking any exercise or other treatment program.

Diet

Like many patients with coronary artery disease caused by atherosclerosis, PAD patients frequently have elevated cholesterol levels that contribute to the disease. A low fat diet and other cholesterol-lowering strategies are often part of a treatment plan.

Stop Smoking

There is no doubt that cigarette smoking is a strong risk factor for PAD. On average, smokers are diagnosed with PAD as much as 10 years earlier than non-smokers. Stopping smoking now is the single most important thing you can do to halt the progression of PAD or prevent it in the future.

Medication

For many patients, lifestyle changes combined with medication can control the symptoms of PAD. Drugs that lower cholesterol or control high blood pressure may be prescribed. New medications that help prevent blood clots or the build up of plaque in the arteries, or that reduce the pain of PAD, also are appropriate for some patients.

Procedures to Open Blocked Blood Vessels

There are a number of ways that physicians can open blood vessels at the site of blockages and restore normal blood flow. In many cases, these procedures can be performed without surgery using modern, interventional radiology techniques. Interventional radiologists are physicians who use tiny tubes called catheters and other miniaturized tools and X-rays to do these procedures.

Sometimes, open surgery is required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons.

Interventional Radiology Treatments for PAD

Angioplasty — a tiny balloon is placed in the blood vessel at the site of the blockage. It is then inflated to open the blood vessel.

Stents — a tiny metal cylinder, or stent, is inserted in the clogged vessel to act like scaffolding and hold it open.

Thrombolytic therapy — clot-busting drugs are delivered to the site of blockages caused by blood clots.

Stent-grafts — a stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.

Atherectomy – A device is used to cut the plaque and remove it.

Angioplasty - In this procedure, an interventional radiologist inserts a very small balloon attached to a thin tube (catheter) into a blood vessel through a small (1/4 inch) nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery.

In some cases, a stent—a tiny cylinder made of metal mesh—is inserted and left behind in the artery to keep it open.

Thrombolytic Therapy. This treatment is used by an interventional radiologist if the blockage in the artery is caused by a blood clot. Thrombolytic drugs—sometimes called "clot busters"—dissolve the clot and restore blood flow. Usually, the drugs are administered through a catheter directly into the clot. These drugs are frequently combined with another treatment, such as angioplasty.

Surgical Treatments for PAD

Most cases of PAD can be treated with lifestyle changes; medications; non-surgical, interventional radiology procedures; or some combination of these treatments. In some severe cases, however, surgery may be required. Procedures performed by a vascular surgeon include:

Thrombectomy. This procedure is used only when symptoms of PAD develop suddenly as a result of a blood clot. In the technique, a balloon catheter is inserted into the affected artery beyond the clot. The balloon is inflated and pulled back, bringing the clot with it. Thrombectomy usually requires surgery.

Bypass grafts. In this procedure, a vein graft from another part of the body or a graft made from artificial material is used to create a detour around a blocked artery.

How do I know which treatment will be the best for me?

The best treatment for PAD depends on a number of factors, including your overall health, the location of the affected artery, and the size and cause of the blockage or narrowing in the artery. You should discuss all your treatment options with your physician. Some questions to ask:

Can my PAD be controlled with lifestyle changes?

What medications might be appropriate for me?

If a procedure is required, am I a candidate for a less invasive, interventional radiology treatment?

What are the risks and benefits of the treatment plan prescribed for me?

Intermittent claudication occurs when oxygen rich blood does not get to the muscles of the hips, thighs, and calves during walking or exercise. Blood vessels that carry blood to the arms, legs, stomach, or kidneys develop fatty deposits called plaque on the inside lining of the artery walls, which restrict blood flow. Chronic disease such as diabetes, high blood pressure, or lifestyle habits such as smoking, being overweight, or lack of exercise can also cause thickening of the artery walls that will restrict blood flow…